人肠道病毒71型和科萨奇病毒A组16型所致手足口病的主临床表现和预后

摘要

目的:人肠道病毒71型(human Enterovirus 71,EV71)和科萨奇病毒A组16型(Coxsackievirus A 16,Cox A16)是引起手足口病的主病毒病原,本文比较了两种病毒致手足口病的主临床表现及其预后.方法:收集201 1年1月至6月南京医科大学附属南京市儿童医院手足口病患者共570例的临床资料及咽拭子标本,采用实时荧光探针PCR法检测患者的咽拭子标本的病毒类型,比较EV71和CoxA16两种病毒引起的手足口病的主临床表现及其预后.结果:350例EV71感染患者平均年龄(2.5±1.7)岁,220例Cox A16感染患者平均年龄(2.3±1.3)岁.EV71感染患者的住院时间长(P＜0.01)；发热超过39℃且持续时间长(P＜ 0.001)；肌阵挛性反射、口腔溃疡都明显偏高(P＜0.05)；咳嗽、热性惊厥明显偏低(P＜0.05)；嗜睡等中枢神经系统感染的临床表现明显偏高(P＜0.05),其中EV71感染患儿经治疗后有3.7%留有四肢肌力下降等后遗症,并有5例死于心肺衰竭；CoxA16感染的患者经过治疗后都治愈且没有留下后遗症.结论:南京地区2011年1月到6月引起的手足口病病毒以EV71为主.相对于Cox A16,EV71引起的临床表现严重、预后差.%Objective: Enterovirus 71 (EV71) and Coxsackievirus A16 (Cox A16) are the main pathogens of the Hand,foot,and mouth disease (HFMD). In this study,we compared clinical manifestation and outcome of HFMD induced by EV71 and Cox A16. Methods: A total of 570 HFMD patients treated in Nanjing Children's Hospital Affiliated with NJMU were enrolled in this study from January to June in 2011. Throat swabs were collected from these patients for detecting virus by real time PCR. Manifestations, outcomes for these patients were analyzed. Results: The average age of 350 patients with EV71 infection was (2.5 ±1.7) years. The average age of 220 patients with CoxA16 infection was (2.3 ± 1.3) years. Patients with EV71 infection had a significantly longer hos-pitalization period (P < 0.001). The main manifestations were fever with a temperature above 391 and lasted longer (P < 0.01). EV71-induced myoclonic jerk,oral ulcer were significantly higher (P < 0.05). EV71-induced cough,febrile seizure were significantly lower (P < 0.05). However,central nervous system complications were significantly higher (P < 0.05). About 3.7% of EV71-infected children had neurologic sequela,and five patients with EV71 infection died of encephalitis and cardiopulmonary failure. All the patients with CoxA16 infection showed total recover. Conclusion: The main pathogen of HFMD was EV 71 in Nanjing region from January to June in 2011. Compared with those patients infected by Cox A16,the children with EV71 infection had serious clinical manifestations and worse outcomes.